AHIC 2.0

The next generation of the American Health Information Community is almost here, yet there are still many more questions than answers.

by Kathryn Foxhall

Will the next few months be formative for the HIT future of the United States?

The organization that will be chosen to form the American Health Information Community's (AHIC) successor is due to be named by November 13, with a transition to the successor scheduled for next spring.

The $13-million public-private cooperative agreement will have the chosen organization design and establish the AHIC's successor organization, and then begin its operation.

This fall and winter, a planning board will convene to determine how the "AHIC 2.0" is to be formed.

In the last two years, the current AHIC, which is an advisory group to the Department of Health and Human Services (HHS), has shepherded the formation of national standards for electronic medical record (EMR) certification and health information technology (HIT) terminology, among other responsibilities. For that reason, the look and form of this new public/private entity — as well as who has access to it — could have a big impact on the healthcare community.

HHS is likely to want to AHIC to continue to use the methods that have contributed to its far reaching influence to date. High level players on its 17-member group include the vice-chairman of Wal-Mart, the assistant secretary of defense for health affairs, the CEO of Blue Cross/Blue Shield and the director of the Federal Office of Personnel Management, among others.

The AHIC has also made well-funded contracts with groups that are coordinating interested players. The goal? To create lasting agreements on, for example, what a certified EHR will look like, and which long-standing languages will be used.

The goal for new public-private partnership is just as ambitious as that for the current AHIC, but on a long-term basis. According to the Office of the National Coordinator for HIT (ONC), it is to develop, "a unified approach to realize an effective, secure, interoperable nationwide health information system."

Building such an influential organization, with so many players volunteering to participate, is a true challenge.

Robert Kolodner, M.D., national coordinator for HIT, recently said that one of the precepts of the AHIC 2.0, "is that it will represent all elements of the health care community and that no one part of the community should control or dominate."

The organization will need to be balanced, he said, and one way to do that is to divide the membership into sectors. But he added that defining those sectors is a challenge as well: Should they be defined by their role, their stake in the organization, or by geography?

Kolodner made clear that all populations would have representation. "Part of our work in the cooperative agreement," he says, "will be to make sure that the design is one that includes the interests of all stakeholders, particularly those of minority and underserved populations."

Governance of the new AHIC 2.0 will be determined in the coming months, specifically whether members will organize themselves or follow pre-prescribed rules on how members will be placed into sectors.

There are many other questions to be answered. Should each member have one vote? Or, for example, in a theoretical insurance sector, should large insurers have more votes than smaller insurers, based on the number of lives they insure?

This new AHIC, Kolodner pointed out, is supposed to be self-sustaining. Where the funds will come from is up for debate. Some feel membership fees may create a barrier to participation. One option being raised is funding from gifts or grants or from sales of products and services. To date, no consensus has been reached.

The influence of AIC can quite possibly be even more far-reaching. Some say that once the National Health Information Network becomes operational, might the AHIC 2.0 provide the governance? That option might prove to be a viable funding source if it decided to charge a few cents per NHIN transaction over the Internet — much like Visa and Mastercard do today.

Right now, AHIC 2.0 is more questions than answers. They'll have to be hammered out once the new organization is named in the few weeks before early spring.

Kathryn Foxhall is a contributing writer based in Hyattsville, Md.

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